Healthcare Reform: Why Neurology Should Be Considered a Primary Care Specialty
The subject of hot partisan debate, the current version of the Senate healthcare reform bill, HR 3590 (the “Patient Protection and Affordable Care Act”), provides a much-needed and long-overdue financial incentive for primary care physicians to continue to offer primary care. In its present version, the proposed bill states,
In the case of primary care services furnished on or after January 1,
20012011, and before January 1, 2016, by a primary care practitioner, in addition to the amount of payment that would otherwise be made for such services under this part, there also shall be paid (on a monthly or quarterly basis) an amount equal to 10 percent of the payment amount for the service under this part.
The bill defines a primary care practitioner as 1) a physician who has a primary specialty designation of family medicine, internal medicine, geriatric medicine, or pediatric medicine,* and 2) a healthcare professional whose billed primary care services make up at least 60% of practice. (Primary care services, defined by CPT codes, are essentially all non-procedure-related services—ie, evaluation and management services.)
The problem with the current wording of the bill—as far as neurologists and their flagship organization, the American Academy of Neurology (AAN), are concerned—is that the primary care incentive omits neurologists: physicians whose practices, like those of traditionally defined primary care physicians, consist of substantial face-to-face time and care.
According to AAN officers in today’s member teleconference, the bill’s oversight is partly due to congressional ignorance: MedPAC, the government agency that makes recommendations to Congress about Medicare policy, mistakenly assumed neurology to be an internal medicine specialty, like rheumatology or endocrinology. (In the eyes of the government, a physician’s specialty is determined by a designated specialty code. Unlike neurologists, rheumatologists or endocrinologists can designate themselves as internal medicine practitioners on the basis of their postgraduate clinical training and/or board certification.) The other gross misjudgment is that neurology is synonymous with the wildly different practice of neurosurgery.
The continued omission of neurology from the bill’s definition of primary care, the AAN reasonably argues, would further erode a valuable medical specialty—which currently matches only 52% of available residency slots.** And yet, despite the shortage of neurologists, their services have been shown (for example, in the case of stroke patients) to reduce hospital stays and costs and to improve clinical outcomes.
The AAN reports that Senator Amy Kobuchar (D-MN) has agreed to introduce an amendment that would add “neurology” to the pertinent section of HR 3590. The proposal is currently in need of a Senate cosponsor. Several patient groups, representing individuals with Parkinson disease, epilepsy, traumatic brain injury, ALS, or headache, advocate the inclusion of neurology in the bill’s incentive section for primary care physicians.
To support the inclusion of neurology as a primary care practice in healthcare reform legislation, the AAN recommends that members visit BrainPAC and write their federal legislators.
* Nurse practitioners, clinical nurse specialists, and physician assistants are also included. In the House bill, obstetricians/gynecologists are included.
** Neurology’s match percentage is comparable to that of family medicine and internal medicine, according to AAN President-Elect Bruce Sigsbee, MD.